Department of Clinical and Administrative Sciences, College of Pharmacy, California Northstate University, Elk Grove, California.
Department of Clinical and Administrative Sciences, School of Pharmacy, Keck Graduate Institute, Claremont, California.
Pharmacotherapy. 2018 Mar;38(3):370-381. doi: 10.1002/phar.2081. Epub 2018 Feb 1.
Recent hypertension clinical trials and national guideline updates have created a debate on the most appropriate treatment goals in elderly patients with hypertension. In 2014, recommendations by the Eighth Joint National Committee allowed a more lenient goal for patients 60 years and older compared with previous guidelines. Since then, several large clinical trials and meta-analyses have added more information regarding strict versus lenient treatment goals. Most recently, the American College of Cardiology and American Heart Association Task Force published their highly anticipated hypertension guideline developed in conjunction with nine additional interdisciplinary organizations. This review discusses the culmination of emerging data to provide more insight into the treatment of hypertension in the elderly. A literature search was conducted using PubMed, the Cumulative Index of Nursing and Allied Health, the Cochrane database, and by hand-searching references from relevant articles. The following key terms were used: hypertension, blood pressure, systolic, and elderly. Available literature suggests that it is reasonable to target an office systolic blood pressure of less than 130 mm Hg in elderly patients with hypertension. An individualized approach is reasonable for those who are institutionalized, with high comorbidity burden, or have a short life expectancy. A diastolic blood pressure of less than 60 mm Hg should be avoided due to the potential for an increase in cardiovascular risk. The method of blood pressure measurement is extremely important to consider when determining the blood pressure goal, and proper procedures for accurate blood pressure measurement must be followed. Other factors important to consider may include the patient's comorbidities, frailty, as well as the patient's potential for adverse drug reactions.
最近的高血压临床试验和国家指南更新引发了一场关于老年高血压患者最合适治疗目标的争论。2014 年，第八版联合国家委员会的建议允许 60 岁及以上的患者有更宽松的目标，与之前的指南相比。此后，几项大型临床试验和荟萃分析增加了更多关于严格与宽松治疗目标的信息。最近，美国心脏病学会和美国心脏协会工作组发布了备受期待的高血压指南，该指南是与其他九个跨学科组织合作制定的。这篇综述讨论了新出现的数据的结果，以提供更多关于老年人高血压治疗的见解。使用 PubMed、护理和联合健康累积索引、Cochrane 数据库以及从相关文章的参考文献中手动搜索进行了文献检索。使用了以下关键词：高血压、血压、收缩压和老年人。现有文献表明，老年高血压患者的诊室收缩压目标控制在 130mmHg 以下是合理的。对于那些住在疗养院的人、有高合并症负担的人或预期寿命短的人，采用个体化方法是合理的。由于心血管风险增加的潜在风险，舒张压应低于 60mmHg。在确定血压目标时，血压测量方法极其重要，必须遵循准确测量血压的正确程序。其他需要考虑的重要因素可能包括患者的合并症、虚弱以及患者发生不良反应的潜在可能性。
